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Frequently Asked Questions


About Hours and Locations

What are TriCore’s hours of operation and locations?
 
To find a Patient Care Center, please click here, Please call the TriCore Client Services team at 505-938-8922 or toll-free at 800-245-3296. We’ll give you directions to the center of your choice if you need help finding the closest Patient Care Center.
 

About Lab Tests

How do I know if my doctor’s order for a lab test is in the TriCore system?
 
Please call Client Services at 505-938-8922 or toll-free at 800-245-3296 and a member of our team will check our laboratory information system to confirm that your orders are in our system.
 
How do I prepare for a test that requires fasting?
 
Please drink water in advance of your test so that you stay hydrated, but do not eat or drink anything else (not even coffee) for 12 hours before your specimen collection.
 
Can I take my medications prior to a lab test?
 
Yes, you may. Drinking water and taking regular medications will not affect your test results.
 
Where can I get instructions for specific tests?
 
TriCore's Patient Care Centers can provide instructions for certain tests. You may also call us at 505-938-8922 or toll-free at 800-245-3296.  
 
When is the best time to visit a Patient Care Center?
 
We follow a first-come, first-served policy, except for patients with special needs. If you’re fasting, you’ll want to come in the morning. If you’ve been given instructions for fasting, please note that it’s important to drink water during your fast so that you’re hydrated when you arrive. If your test does not require fasting, please help us provide quicker service by arriving in the afternoon, when wait times are generally shorter.
 
What should I bring?
 
Be sure you have your insurance card, your driver’s license or another valid form of photo identification and your completed requisition (test order). Please let us know if there are any recent changes in your personal information, including your name, address, phone number or insurance plan.
 
What if I have a reaction to my blood draw?
 
Reactions to blood draws are rare and usually mild. Experts generally recommend that you eat a healthy meal, drink plenty of fluids and avoid heavy lifting for 12 hours after a blood draw. Click here for a full list of precautions.
 
How can I give you feedback on my experience?
 
You may call Client Services at 505-938-8922 or toll-free at 800-245-3296, or click on the “Tell Us What You Think” link on the patient page and complete the online form. If you provide your name and contact information, we’ll respond to your comments.
 

About Laboratory Results

Why do physicians order laboratory tests?
 
Doctors order lab tests as part of a routine checkup to look for changes in your health or to diagnose medical conditions and monitor the progression of a disease. Estimates suggest that about 70 percent of decisions about patient treatment are based on the results of lab tests.
 
How do I get my test results?
 
TriCore sends your lab results directly to your doctor, who can best explain their significance to you. While we prefer that you see your doctor for details, you may also ask us for a copy of your results when you arrive for your lab test, by phone 24 hours a day at 505-938-8922 or toll-free at 800-245-3296 or in person after the time of service.
 
What safeguards do you have in place to protect the confidentiality of my results?
 
TriCore values the privacy of your health information and is required by federal law to protect it. Our HIPAA Notice of Privacy Practices for Protecting Health Information explains the ways in which TriCore may use and disclose medical information by law. To view our complete HIPAA Notice of Privacy Practices, please click here.
 
Can my family members request a copy of my test results?
 
All requests for medical records from family members must be addressed to Client Services at 505-938-8922 or 800-245-3296 and will be reviewed by the TriCore Legal and Risk Services department.
 
How Can I Authorize Someone to Request My Test Results?
 
You can complete an Authorization Form that tells TriCore that you permit a specific individual (e.g., your spouse, your son, your friend) to request your test results. You may download the form here along with instructions for completing it and submitting it to TriCore.
 

About Billing

I have insurance. Why are you billing me? 
 
TriCore does not send a bill to patients while insurance claims are being processed. If you have received a bill, it means that TriCore does not have your valid insurance information, or we have received information from your insurance company indicating that you are responsible for a portion of the cost of our services.
 
Was my insurance billed?
 
Please read your bill carefully. Your first bill will reflect all of the charges and any insurance payments we have received from your health plan. If you do not see any payments listed from your insurance company, please feel free to contact our Billing Department at 505-247-0244 or 877-267-2428. It’s possible that we did not receive valid insurance information with your lab orders. Please call our Billing Department and provide your current insurance information.
 
Why isn’t my health plan paying 100 percent?
 
Individual health plans vary greatly. If you feel that your insurance provider has processed your claim incorrectly and should have paid more, please contact your insurance company for details.
 
Why won’t you bill my secondary insurance?
 
TriCore does not automatically file claims with your secondary insurance carrier unless your primary or secondary insurance is considered a government payer (such as Medicare, Medicaid or TriWest).
 
How do I submit a claim to my secondary insurance?
 
You should have received an Explanation of Benefits (EOB or Remittance Advice) from your primary insurance provider detailing payment or denial of services rendered. Please mail this form, along with your TriCore bill, to your secondary insurance provider. You can also contact your insurance plan for more specific details.
 
Why isn’t this test covered?
 
Individual health plans vary greatly. If you feel your insurance provider has processed your claim incorrectly and should have paid more, please contact your insurer for details.
 
Why isn’t this covered by Medicare?
 
Medicare does not provide coverage or has very limited coverage for some routine laboratory tests. In addition, Medicare has strict requirements about the medical necessity of the tests ordered. If your physician has ordered a test that has medical necessity requirements, TriCore or your physician will administer an Advance Beneficiary Notice to you advising that Medicare may not pay for the ordered tests. If you wish to proceed with testing anyway, your signature is required acknowledging financial responsibility for any services for which coverage has been denied.
 
Can the diagnosis be changed to reflect a "routine" visit so my claim will be paid at 100 percent?

TriCore does not assign diagnoses; this function is performed by your healthcare provider. Providers base their diagnoses on the signs and symptoms that are present during your office visit. If you were scheduled for a routine visit but ended up also discussing other health matters, your insurance company might not consider the visit to have been routine when the time comes to pay your claim, If you have questions about claims payments as they relate to your diagnosis, you should contact your insurance company.
 
My insurance states they will pay my claim if the CPT code is changed. Can TriCore change the CPT code so my insurance will pay?
 
TriCore’s medical directors make every effort to correctly interpret CPT codes and apply them appropriately to the methodology of testing performed. TriCore will not change a CPT code to increase reimbursement from insurance carriers.
 
Why is my bill so much?
 
While TriCore performs many routine clinical laboratory tests, we also perform many complicated esoteric tests such as genetic testing and molecular diagnostic testing. These complicated tests can be expensive and may not be covered by your insurance plan. If you’re uncertain why your insurance has denied a claim or paid it at a lesser rate, please contact your insurance company.
 
What is my balance after insurance?
 
You should have received an Explanation of Benefits (also called an EOB or Remittance Advice) from your insurance carrier advising you of your patient responsibility for or co-insurance, deductible, any denied services or the like. If your bill does not match the amount on your EOB, please contact our Billing Department.
 
Will TriCore bill non-contracted insurance plans?
 
TriCore can submit claims to payers we are not contracted with. But if the claim is denied, we expect patients to make full payment.
 
Why do I have to provide billing information every time I have lab services?
 
Each visit is treated as a new encounter to ensure that TriCore receives the most current and accurate billing information. This helps to avoid delays in resolving your claim.
 
Who do I contact to provide updated insurance information?

Please contact a representative in our Billing Department at 505-247-0244 or 877-267-2428.
 
How often will TriCore bill me?
 
TriCore will send you a bill approximately once a month once it has been determined that the balance due is your responsibility.
 
Can I pay my account online?
 
Yes. TriCore provides the option to make a payment via credit card or e-check. Click here to make a patient payment.
 
I don’t have insurance. Does TriCore offer any self-pay discounts?
 
TriCore does offer an uninsured discount on qualified laboratory tests. Please contact our Billing Department within 14 days after receiving your first bill for additional information.
 
Can I make payment arrangements? 
 
TriCore will consider payment arrangements on a case-by-case basis. Please contact our Billing Department at 505-247-0244 or toll-free at 877-267-2428 for more information.
 
What insurance does TriCore accept?

TriCore accepts nearly all New Mexico insurance plans, Click here for a list of insurance providers who contract with us.
 

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1001 Woodward Place NE
Albuquerque, NM 87102

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